| NPI | 1548780133 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5241) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VT 030.0133932) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2020-12-04 |