| NPI | 1912578592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WY 445t) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-5301) |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2025-09-18 |