| NPI | 1912081514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP562) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA OP562) |
| 152W00000X Optometrist (Licence: MD OP562) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-08 |