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 |