| NPI | 1205036993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 002391) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1287) |
| 152W00000X Optometrist (Licence: IL 046010056) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2016-11-18 |