| NPI | 1255112397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 030.0133999PROV) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WV 3032-IOD) |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2024-04-10 |