| NPI | 1740422336 |
|---|---|
| Former Name | NICOLE MARIA ANTZOULIDES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 013201) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 013201-1) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2021-02-08 |