| NPI | 1205814365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 6517T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2152) |
| 152W00000X Optometrist (Licence: OR 2802T) | |
| Enumeration Date | 2006-01-08 |
| Last Update Date | 2007-07-08 |