| NPI | 1104441989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FERNANDO LUIS VILLAMIL WISCOVITCH Provider 918-813-3901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2021-10-22 |