| NPI | 1164704680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.010498) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003709A) |
| Enumeration Date | 2011-09-10 |
| Last Update Date | 2015-05-13 |