| NPI | 1912648395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003436) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 2354) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2022-07-07 |