Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 081794 | CA |
NPI | 1003935164 |
---|---|
Provider Name | Mr. Wilfred Lilje |
First Address | Woodland Hills, CA 91364-3301 |
Second Address | Woodland Hills, CA 91364-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 14/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
081794 | CAADE (01) | CA |
7364-1095 | AMERICAN PSYCHOLOGICAL ASSOCIATION (01) | CA |
RW1300 | CCBADC (01) | CA |