Personal Data
- First name
- lcare Antoine
- Family name
- Perret
- Civil status
- divorced
- Date of birth
- 13. January 1960
- Gender
- Male
- Citizenship
- swiss
- Address
- Darëzezë e re
- City
- Fier
- Zip Code
- 9309
- Contact numbers:
- Phone
- +355692688892
- khayim@steinwolf.org
Person to notify in case of emergency
- Your relation with this person
- Name
- Address
Medical data
- Are you presently receiving any medical treatment or under medical review?
- Bood group
- 1. Allergy
- Details of allergy
- 2. Diabetes
- Diabetes Details