| NPI | 1629119862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 3078) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001329) |
| 152W00000X Optometrist (Licence: MA 4854) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2015-01-27 |