| NPI | 1558372052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 1874) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100216) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2011-08-09 |