| NPI | 1689960601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2011019755) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MO 2011019755) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2020-06-10 |