Individual
FRANCISCO ROBERTO LARA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
490 WESTPORT AVE, NORWALK, CT 06851-4424
(203) 614-9635
Mailing address
490 WESTPORT AVE, NORWALK, CT 06851-4424
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1234
CT
Other
Enumeration date
06/04/2019
Last updated
06/04/2019
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