| NPI | 1922615103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003009) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009249) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2022-11-29 |