| NPI | 1255469748 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1388) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 002411) |
| 152W00000X Optometrist (Licence: TX 4725TG) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2017-01-18 |