| NPI | 1700104304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002013) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2196) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2015-05-04 |