| NPI | 1649411133 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001821) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001950) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2009-03-13 |