| NPI | 1750379673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 1089T) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: OR 1089T) |
| 152WV0400X Optometrist, Vision Therapy (Licence: OR 1089T) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2007-12-04 |