| NPI | 1508860065 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY T006563-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL TPOP17) |
| 152W00000X Optometrist (Licence: WI 21313-875) | |
| Enumeration Date | 2005-06-11 |
| Last Update Date | 2022-03-06 |