| NPI | 1417063066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.010196) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5598) |
| 152W00000X Optometrist (Licence: NV NV 752) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2013-12-23 |