Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 103K00000X | Behavior Analyst | 218 | CT |
NPI | 1003306820 |
---|---|
Provider Name | Anton Yurack |
First Address | Farmington, CT 06032-1728 |
Second Address | Farmington, CT 06032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 06/08/2018 |