| NPI | 1073677845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MIKELL BOVA President 435-640-6220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: UT 6053003-1204) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: UT 185699) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: UT 6053003-1204) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-08-22 |