| NPI | 1922315282 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 60242185) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4827) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2021-03-23 |