| NPI | 1972683746 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2006016870) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1712) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |