Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 025389 | NY |
NPI | 1003408543 |
---|---|
Provider Name | Kevin Liu |
First Address | New York, NY 10019-1320 |
Second Address | New York, NY 10019-1320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2021 |
Last Update Date | 05/02/2021 |