| NPI | 1235705849 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002518) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3726) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2021-10-13 |