| NPI | 1174789721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1752) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2008020588) |
| 152W00000X Optometrist (Licence: UT 9291202-9934) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2019-04-25 |