Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1200X | Ergonomics | 1632 | ND |
Y | 225XE1200X | Ergonomics | 1632 | ND |
NPI | 1821382508 |
---|---|
Provider Name | Bryce Fast |
First Address | Bismarck, ND 58501-4332 |
Second Address | Bismarck, ND 58504-6631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 31/05/2011 |