| NPI | 1629483177 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1973) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2014017406) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2015-08-18 |