| NPI | 1811075401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2216) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 6424033) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-02-28 |