| NPI | 1790953594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618000672) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1023) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |