| NPI | 1568825156 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 4302ATI) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: OR 4302ATI) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2018-07-23 |