a ° Warsaw CLASSIFICATION LEVEL (CHECK ONE) IDIJNCLASSIFIED, NOT SENSITIVE °SENSITIVE, BUT UNCLASSIFIED (=CONFIDENTIAL =SECRET • ATTENTION: ma Atnagnmat rfetam EFTA01726191 NLETS RESPONSE DR.TN0000e0e~ TXT NAME: ADDRESS: DR LIC NO:M MIE BIRTH DATE: LIC CLASS: D"' LICEND: SOC: PREVIOUS CLA