| NPI | 1376535187 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-001673) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 02240) |
| 152W00000X Optometrist (Licence: NE 1172) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2022-05-19 |