| NPI | 1679826135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1520) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2015012018) |
| 152W00000X Optometrist (Licence: TX 5564) | |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2020-09-18 |