| NPI | 1346907219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003140) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.007018) |
| Enumeration Date | 2021-11-26 |
| Last Update Date | 2023-08-01 |