| NPI | 1235851650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2369DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 09670) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2024-05-07 |