| NPI | 1215137732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60063073) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 5096T) |
| 152W00000X Optometrist (Licence: CA 10774) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2009-12-22 |