The holder whose full name is Bormann, Thomas Joseph,come from Michigan City IN,hold the Dental Anesthesia Permit - Light Parenteral Conscious Sedation license(NO.43000173A) which status is Active.
| Name | Bormann, Thomas Joseph |
|---|---|
| License Number | 43000173A |
| License Type | Dental Anesthesia Permit - Light Parenteral Conscious Sedation |
| License Status | Active |
| City | Michigan City |
| State | IN |