| NPI | 1366704611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60639931) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3592ATI) |
| 152W00000X Optometrist (Licence: MO 2014027649) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2021-06-09 |