| NPI | 1689297210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005478) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: TX 9820T) |
| 152WV0400X Optometrist, Vision Therapy (Licence: TX 9820T) | |
| 152W00000X Optometrist (Licence: TX 9820T) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-08-18 |