| NPI | 1275653602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1488) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001385) |
| 152W00000X Optometrist (Licence: MD ta1827) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2007-07-08 |