| NPI | 1205065588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004563) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5847) |
| 152W00000X Optometrist (Licence: KY 1773DT) | |
| 152W00000X Optometrist (Licence: OH T2761) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2023-06-12 |