Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373218 |
---|---|
Provider Name | Benjamin Cowe |
First Address | Benton Harbor, MI 49022-2469 |
Second Address | Benton Harbor, MI 49022-2469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2019 |
Last Update Date | 23/02/2019 |