| NPI | 1730170697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004417) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TU006490-1) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2008-09-08 |