| NPI | 1750533352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004562) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 7302T) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2010-06-22 |