Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 35-87246 | OH |
NPI | 1013946821 |
---|---|
Provider Name | Indra P Li Mbu |
First Address | Youngstown, OH 44510-1716 |
Second Address | Youngstown, OH 44510-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 08/07/2007 |