| NPI | 1922406933 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 3104) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG004001) |
| 152W00000X Optometrist (Licence: MD TA3031) | |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2024-09-03 |