| NPI | 1710614219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3810) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901005762) |
| 152W00000X Optometrist (Licence: WI 3983-35) | |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2024-11-20 |