| NPI | 1619011061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4511) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13235) |
| 152W00000X Optometrist (Licence: TX 6559T) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2008-05-29 |