| NPI | 1972503076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE C130001159) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE005871T) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2019-10-18 |