NPI | 1891028189 |
---|---|
Former Name | KAREN ELIZABETH GUSTAFSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: IL 036-133393) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 57. 016191) |
Enumeration Date | 2009-09-17 |
Last Update Date | 2014-01-31 |