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