| NPI | 1629456181 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5042) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002977) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2015-05-15 |