| NPI | 1699055780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2565) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14506) |
| 152W00000X Optometrist (Licence: OR 3426AT) | |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2021-06-03 |