| NPI | 1912389891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003056) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003042) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2022-08-25 |