| NPI | 1508814252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1260) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 2053) |
| 152W00000X Optometrist (Licence: PA OEG000195) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-05-01 |