| NPI | 1912955782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60336291) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100590) |
| 152W00000X Optometrist (Licence: CO OPT.0001207) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 8067) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-05-21 |