| NPI | 1710971528 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003039) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-890) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2007-07-09 |