| NPI | 1790035103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6139, T3054) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4971) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2020-10-07 |