Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301119020 | MI |
NPI | 1003170564 |
---|---|
Provider Name | Norimitsu Kuwabara |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 13/06/2019 |