| NPI | 1952667875 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP100005) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD 3200) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2012-04-04 |