| NPI | 1215312913 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2015020225) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP1000367) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2020-12-03 |