| NPI | 1235124389 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5275) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1821) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2018-12-31 |