| NPI | 1578841094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004794) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ME OPT929) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2013-08-12 |