| NPI | 1568873123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3411) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14887) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2014-10-02 |