| NPI | 1457569378 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3074) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3062035) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2015-10-28 |