| NPI | 1720392392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002390) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1621-654T) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2020-12-03 |