| NPI | 1699931139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI WI 3116-035) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3192) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2009-10-13 |