| NPI | 1912096967 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA od60958770) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2733ATI) |
| 193400000X Single Specialty (Licence: OR 2733ATI) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-07-11 |