| NPI | 1497959456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GU OL-049) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE 13-0001387) |
| 152W00000X Optometrist (Licence: PA OE008223T) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2021-07-13 |