| NPI | 1538358197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002613) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2007032272) |
| 152W00000X Optometrist (Licence: MA 4685) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2012-01-23 |