| NPI | 1730278268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 776) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WY 300T) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2016-05-10 |