| NPI | 1811052079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0895) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000280) |
| 152W00000X Optometrist (Licence: VA 0601001213) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2013-01-10 |