| NPI | 1679587828 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2368) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ND 512) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2008-03-04 |