| NPI | 1780100180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS J AUGUSTIAN CEO 920-490-9046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2022-04-20 |