| NPI | 1801151113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004816) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6115) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2014-12-01 |