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Individual
BRUCE WAYNE CARLSON
Active
Individual
BRUCE WAYNE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AART
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
3390
NE
247200000X
Other Technician
Primary
CRT6075
FL
247200000X
Other Technician
GN130999
WY
247200000X
Other Technician
RHT90772
CA
Other
Enumeration date
05/11/2007
Last updated
07/08/2007
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