| NPI | 1629639455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003245) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002792) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2024-04-15 |