| NPI | 1558918458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005418) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3873-35) |
| Enumeration Date | 2019-08-25 |
| Last Update Date | 2026-06-01 |