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Name (in full) *

Qualification *

Speciality

Organisation

Designation *

Gender *

Male

Female

Medical council registration number

Place of registration

Basic Degree (MBBS)

Year of Joining

Year of Passing

College /Institution

Degree awarded by

Certificate

Degree (General Surgery)

Year of Joining

Year of Passing

College /Institution

Degree awarded by

Certificate

Degree (Cardiovascular and Thoracic Surgery)

Year of Joining

Year of Passing

College /Institution

Degree awarded by

Certificate

Other (degrees/qualifications)

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