| NPI | 1215318654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5270) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT0003128) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2016-09-08 |