| NPI | 1770674160 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3164) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002322) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2013-08-02 |