| NPI | 1871047365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETSY J WERNLI President 920-482-0671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2019-08-01 |