| NPI | 1417361403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003850A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6310) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2021-06-01 |