NPI | 1053691535 |
---|---|
Former Name | CHARLES WILLIAM WIKLE |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 401341) |
Enumeration Date | 2011-08-28 |
Last Update Date | 2023-06-13 |