Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 19969 | HI |
NPI | 1174053136 |
---|---|
Provider Name | Dr. Michael Angelo Soler |
First Address | Fort Gordon, GA 30905-5650 |
Second Address | Pyeongtaek, PYEONGTAEK 96273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2017 |
Last Update Date | 16/12/2020 |