| NPI | 1972596252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 14833) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T03323) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2007-12-06 |