| NPI | 1336402668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3319) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3263-035) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2013-08-05 |