Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | DC-04896 | OH |
NPI | 1326685611 |
---|---|
Provider Name | Dr. Sean Nikolas Wunderle |
First Address | Brunswick, OH 44212-6477 |
Second Address | Brunswick, OH 44212-6477 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2019 |
Last Update Date | 05/12/2019 |