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Individual

DARRRIUS CLAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
6808 UNIVERSITY AVE STE 108, MIDDLETON, WI 53562-2779
(608) 225-4037
Mailing address
6808 UNIVERSITY AVE STE 108, MIDDLETON, WI 53562-2779

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
C4001619522202
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
92-1469139
WI
Enumeration date
01/04/2023
Last updated
01/04/2023
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