| NPI | 1215667290 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 6090) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 4021) |
| 152W00000X Optometrist (Licence: MD TA3125) | |
| 152W00000X Optometrist (Licence: NY 011292) | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2025-12-16 |