| NPI | 1790817559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 3916) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3024) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2018-10-19 |