| NPI | 1912960923 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004317) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 06748TG) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2021-04-01 |