| NPI | 1104009166 |
|---|---|
| Other Name | MARJORIE BAGWELL KUKOR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6340) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6340) |
| 103T00000X Psychologist (Licence: MO PPY01684) | |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2009-09-08 |