| NPI | 1376696708 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2002015313) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 2952) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2014-11-18 |