| NPI | 1306806393 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001012) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT000487E) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2007-11-26 |