| NPI | 1750795365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 2047-IOD) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 073808) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2019-01-10 |