| NPI | 1497852040 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN MN 2563) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2885 - 035) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2007-07-09 |