| NPI | 1780097212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP1000360) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002538) |
| 152W00000X Optometrist (Licence: PA OEG002905) | |
| 152W00000X Optometrist (Licence: MD TA2566) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2024-02-23 |