| NPI | 1790205581 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 107333) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2017017941) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-10-28 |