| NPI | 1720194756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 2617) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 1248) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2023-01-10 |