Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 1172000 | DE |
NPI | 1053935825 |
---|---|
Provider Name | Mr. Garrett Evan Benham |
First Address | Newark, DE 19702-1668 |
Second Address | Newark, DE 19713-2049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2020 |
Last Update Date | 22/02/2021 |