| NPI | 1629401575 |
|---|---|
| Former Name | TREVOR MATHIAS FRIDERES |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10577) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60394053) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2019-01-27 |