| NPI | 1760968895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3646) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.006635) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2023-06-28 |