| NPI | 1992258602 |
|---|---|
| Former Name | BRENT DOUGLAS DENISAR |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3386) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15799) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2016-07-28 |