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Individual
MR. HANNIBAL BAUTISTA
Active
Individual
MR. HANNIBAL BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
18884
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S39033501
DRIVER'S LICENSE
MA
Enumeration date
10/05/2010
Last updated
10/05/2010
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