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Individual
ETHAN LARSEN
Active
Individual
ETHAN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
12298266-4810
UT
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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