| NPI | 1720065964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL R-170-TA-810) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001240) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2025-06-12 |