| NPI | 1902161045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002810) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 2283) |
| 152W00000X Optometrist (Licence: SC 1709) | |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2014-09-11 |