Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 10173233 | OR |
NPI | 1003274622 |
---|---|
Provider Name | Lionel Daniel |
First Address | Woodland Hills, CA 91367 |
Second Address | Beaverton, OR 97005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2016 |
Last Update Date | 10/02/2016 |