| NPI | 1790135424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008421) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002899) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-09-21 |