| NPI | 1548558935 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 490100462) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: MI 4901004652) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2011-12-22 |