| NPI | 1972580124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001739) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 2877) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2012-07-26 |