| NPI | 1235350745 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3154) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 6911TG) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2022-10-10 |