| NPI | 1790072643 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 0003041) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: CO 0003041) |
| 152WV0400X Optometrist, Vision Therapy (Licence: CO 0003041) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2021-06-23 |