| NPI | 1699730036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2847) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ND 609) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2009-11-11 |