Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-19-102934 | FL |
NPI | 1003313404 |
---|---|
Provider Name | Aigbovboise Ayo Ehabahe |
First Address | Florida City, FL 33034 |
Second Address | Florida City, FL 33034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2018 |
Last Update Date | 02/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104576900 | (05) | FL |