Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1083209795 |
---|---|
Provider Name | Michael Nguyen |
First Address | Ontario, CA 91764-5104 |
Second Address | Ontario, CA 91764-5104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2021 |
Last Update Date | 04/03/2021 |