| NPI | 1235650797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC NC2654) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC NC2654) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2023-10-19 |