Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 626 | MN |
NPI | 1497846836 |
---|---|
Provider Name | Mr. Bruce Alan Gasser |
First Address | Sartell, MN 56377-2241 |
Second Address | Saint Cloud, MN 56303-2015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |