| NPI | 1235262890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 3034) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2496ATI) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2010-08-26 |