| NPI | 1578147732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10675T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL T-249-TA-C14) |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2022-09-16 |