| NPI | 1790881514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003437) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100200) |
| 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-579) | |
| 152W00000X Optometrist (Licence: WA 3437) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2020-11-19 |