Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1245688910 |
---|---|
Provider Name | Mr. Akeem M Williams |
First Address | Ft Riley, KS 66442-7009 |
Second Address | Ft Riley, KS 66442-7009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2016 |
Last Update Date | 02/06/2016 |