| NPI | 1740420686 |
|---|---|
| Former Name | MICHELLE MARJORIE KUBANCIK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2108) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002283) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2013-02-07 |