| NPI | 1790829935 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2310) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 3614) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2009-08-24 |