| NPI | 1841546074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2013021015) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2743) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2013-08-19 |