Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 2018023328 | MO |
NPI | 1003302977 |
---|---|
Provider Name | Dr. Dylan Grau |
First Address | Kansas City, MO 64139-1236 |
Second Address | Kansas City, MO 64139-1246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2018 |
Last Update Date | 24/09/2019 |