Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003375502 |
---|---|
Provider Name | Peter Nguyen |
First Address | Irvine, CA 92606-7674 |
Second Address | Garden Grove, CA 92840-4694 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 11/06/2019 |