| NPI | 1790770063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT 13194 TPA) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4135) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2012-11-15 |