| NPI | 1639315997 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PR 657) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPTO02575) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2020-10-05 |