| NPI | 1639677560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVIN PETTIET Current Rep 832-296-4665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2019-09-12 |