Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | ME 104282 | FL |
N | 207W00000X | Ophthalmologist | ME104282 | FL |
NPI | 1073791950 |
---|---|
Provider Name | Hari Vs Brundavanam |
First Address | Lawrenceville, NJ 08648-1334 |
Second Address | Trenton, NJ 08638-4143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2008 |
Last Update Date | 17/03/2018 |