| NPI | 1821096116 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60276428) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2807T) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2016-09-29 |