| NPI | 1679311690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: WI 4034-35) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2024-09-26 |