| NPI | 1649463621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1769) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2007035557) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2019-10-02 |