| NPI | 1205859576 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 1987) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003640) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-09 |