| NPI | 1386905537 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007805-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4886) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2017-03-01 |