| 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 |