| NPI | 1215290689 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-C88) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL S-C88-TA-936) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-02-18 |