| NPI | 1164572970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 0862) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: AZ 0862) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-07-08 |