| NPI | 1295352987 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005481) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 10379T) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2021-12-09 |