Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH0003012 | FL |
NPI | 1417173055 |
---|---|
Provider Name | Dr. David Michael Bernstein |
First Address | Fort Lauderdale, FL 33334-3522 |
Second Address | Fort Lauderdale, FL 33334-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250244 | (02) | FL |