| NPI | 1639142334 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3119) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MA 3119) |
| 152WP0200X Optometrist Pediatrics (Licence: MA 3119) | |
| 152WS0006X Optometrist Sports Vision (Licence: MA 3119) | |
| 152WX0102X Optometrist Occupational Vision (Licence: MA 3119) | |
| Enumeration Date | 2006-02-12 |
| Last Update Date | 2012-05-30 |