| NPI | 1497758775 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2810) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3025-035) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2012-04-26 |