| NPI | 1790209708 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2519) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 2009) |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2018-08-16 |