| NPI | 1578086427 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005149) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003307) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2019-11-21 |