Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 005955 | AZ |
NPI | 1275815888 |
---|---|
Provider Name | Damian Bundschuh |
First Address | Scottsdale, AZ 85258-4581 |
Second Address | Scottsdale, AZ 85258-4581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2011 |
Last Update Date | 10/01/2013 |