Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1033716097 |
---|---|
Provider Name | Christopher Ballantine |
First Address | San Diego, CA 92107-2719 |
Second Address | Billings, MT 59101-0913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2020 |
Last Update Date | 02/10/2020 |