| NPI | 1629166772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004298) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00004115) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2009-04-14 |