| NPI | 1649687443 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60660403) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8430T) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2019-02-25 |