| NPI | 1760454730 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03249) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1468) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2011-03-31 |