| NPI | 1164777975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 14680) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002676) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2020-04-16 |