| NPI | 1649530361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN P GERVAIS Audiologist 218-623-1045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 231H00000X Audiologist (Licence: MN 6443) |
| Additional Taxonomies | 231H00000X Audiologist |
| 237600000X Audiologist-Hearing Aid Fitter | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2020-05-19 |