| NPI | 1972595932 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 99177799) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-008784) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2007-07-08 |