| NPI | 1417915935 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2001016965) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009634) |
| 152W00000X Optometrist (Licence: KS 1594) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2012-08-31 |