| NPI | 1790036325 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4721) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002695) |
| Enumeration Date | 2012-09-22 |
| Last Update Date | 2022-02-28 |