| NPI | 1255438057 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 2095) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL S797-TA-342) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-04-29 |