| NPI | 1407738289 |
|---|---|
| Other Name | JAKE ERICKSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 8971560) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID 8971560) |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-08-28 |