Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1598952764 |
---|---|
Provider Name | Stefan Gran |
First Address | Walnut Creek, CA 94596-3716 |
Second Address | Walnut Creek, CA 94596-3716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2007 |
Last Update Date | 01/10/2007 |