| NPI | 1639522410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5236) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA oeg003126) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2023-01-31 |