| NPI | 1609247808 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 2139DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8706T) |
| 152W00000X Optometrist (Licence: CA 15406) | |
| 152W00000X Optometrist (Licence: IN 18004147A) | |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2019-08-20 |