| NPI | 1912062837 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO TO3126) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1402) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2017-03-07 |