| NPI | 1578258968 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003570) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA OPT5635) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2024-10-02 |