| NPI | 1912429622 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP1000366) | 
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2710) | 
| 152W00000X Optometrist (Licence: VA 0618002600) | |
| Enumeration Date | 2017-07-13 | 
| Last Update Date | 2025-05-01 |