| NPI | 1710090634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2000160783) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1642) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2013-01-16 |