Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1811088347 |
---|---|
Provider Name | Mr. Ariston Dizon Bautista |
First Address | Dayton, OH 45424-8123 |
Second Address | Dayton, OH 45428-9000 |
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 |