| 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 |