| NPI | 1336514694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 33755TLG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT6428) |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2021-03-11 |