| NPI | 1619366036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003116) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL opc4985) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2021-11-08 |