| NPI | 1972620714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 2093) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1250-398T) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-08-01 |