| NPI | 1174623532 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1771) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2006026260) |
| 152WP0200X Optometrist Pediatrics (Licence: MO 2006026260) | |
| 152WP0200X Optometrist Pediatrics (Licence: KS 1771) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2009-06-29 |