| NPI | 1588140636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5873) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003421) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2020-12-04 |