| NPI | 1689135592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5710) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL PENDING) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2019-07-03 |