| NPI | 1205601317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2992) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618003363) |
| 152W00000X Optometrist (Licence: TX 10905T) | |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2024-02-16 |