| NPI | 1578930764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046.010951) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 346.003704) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |