| NPI | 1619283256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4539) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: FL opc4539) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2019-04-26 |