| NPI | 1164713392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3303) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ND 698) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2014-07-22 |