| NPI | 1568877744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004918) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010811) |
| 152WP0200X Optometrist, Pediatrics (Licence: MI 4901004918) | |
| 152WP0200X Optometrist, Pediatrics (Licence: IL 046010811) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2017-12-04 |