| NPI | 1770818858 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WY 408T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3270) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2017-01-25 |