| NPI | 1780731471 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1648) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2034) |
| 152W00000X Optometrist (Licence: PA OEG001793) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2014-11-26 |