| NPI | 1659307932 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3152 ATI) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2475) |
| 152W00000X Optometrist (Licence: WA 4096) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2007-07-08 |