| NPI | 1508962879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3129-035) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 02325) |
| 152W00000X Optometrist (Licence: MN 3263) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2012-01-24 |