| NPI | 1306825450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT001047) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPT001915) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2013-02-12 |