| NPI | 1205947736 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002811) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN MN 3191) |
| 152W00000X Optometrist (Licence: MA MA4591) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-05-28 |