| NPI | 1962143180 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 2509) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2022026133) |
| Enumeration Date | 2022-04-03 |
| Last Update Date | 2026-04-10 |