Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MFC1847 | FL |
NPI | 1235616632 |
---|---|
Provider Name | Daiki Soma |
First Address | Gainesville, FL 32610-0118 |
Second Address | Gainesville, FL 32610-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2018 |
Last Update Date | 20/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111689100 | (05) | FL |