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 |