| NPI | 1760903520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WY 421T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA oed003273) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-03-02 |