| NPI | 1962758078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3665) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 2750) |
| 152W00000X Optometrist (Licence: OK 2750) | |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2022-04-01 |