| NPI | 1164599486 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00004040) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT 12971 TPA) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |