| NPI | 1588072755 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO opt0003429) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4929) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2019-08-06 |