| NPI | 1235154220 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003579) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 290035) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-08 |