| NPI | 1558611871 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60726616) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002158) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2022-07-21 |