Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A89591 | CA |
NPI | 1336297365 |
---|---|
Provider Name | Reza Bolourian |
First Address | Powell, OH 43065-9189 |
Second Address | Powell, OH 43065-9189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 22/09/2011 |