| NPI | 1700641438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL JONATHAN TOMAS Owner 253-400-0218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-21 |