| NPI | 1609164094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3243) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3223-35) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2020-08-11 |