| NPI | 1962011601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5516) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009206) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2021-12-10 |