| NPI | 1417282195 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 002567) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2009024362) |
| 152W00000X Optometrist (Licence: KS 1845) | |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2016-06-03 |