| NPI | 1578175725 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: TX 9779T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9779T) |
| 152WS0006X Optometrist, Sports Vision (Licence: TX 9779T) | |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2021-07-23 |