| NPI | 1699556514 |
|---|---|
| Other Name | BRENT LAGUE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015153A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16449-24) |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2024-10-17 |