Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 23713 | CT |
NPI | 1063523082 |
---|---|
Provider Name | Gary Vincent Desir |
First Address | Woodbridge, CT 06525-1654 |
Second Address | West Haven, CT 06516-2770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |