| NPI | 1508941410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3455) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002412) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2011-10-13 |