| NPI | 1639217417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2805) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3052) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2015-03-02 |