NPI | 1386942803 |
---|---|
Former Name | MELISSA DIBBLE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA055179) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP00252800) |
Enumeration Date | 2011-03-08 |
Last Update Date | 2018-06-26 |