NPI | 1225272412 |
---|---|
Former Name | JORDAN D DIMITRAKOV |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 244988) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA PENDING) |
207RA0000X Internal Medicine, Adolescent Medicine (Licence: MA PENDING) | |
208800000X Urology (Licence: MA PENDING) | |
208800000X Urology (Licence: MA 244988) | |
Enumeration Date | 2009-05-01 |
Last Update Date | 2011-05-23 |