| NPI | 1588235931 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003827) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA 123456) |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2021-07-21 |