| NPI | 1902841448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60348374) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00586100) |
| 152W00000X Optometrist (Licence: NY TUV6585-1) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2017-01-31 |