| NPI | 1437216439 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2110) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2154) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2014-12-15 |