| NPI | 1821091034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4122) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MA 4122) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MA 4122) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2014-03-14 |