Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 83154 | SC |
NPI | 1003278862 |
---|---|
Provider Name | Michael Damaso De Guzman |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-4423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 07/12/2021 |