My Profile

General Information

My Membership :
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Date of Birth :
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Mobile Number :
Father's Name :
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Current Practice Title :
Work Experience :
Awards :

Permanent Address

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Clinical Address

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Medical Council Registration

MCI Registration (MCI/State Medical Council Number) :
Authority (MCI/Name of State Medical Council) :
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Is ASI Number : No
ASI Registration Number :
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Qualifications

Qualification Name Degree College University Years of Passing

Current Endoscopic/Laparoscopic Experience

Procedure Experience (in years) No of Procedures (past 1 year) No of Procedures (past 5 year)
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