| NPI | 1962852608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD3409) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA 2531) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2022-07-21 |