| NPI | 1811201304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2802) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5967) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2012-09-27 |