International CTEPH Association

Kindly complete your registration by providing the details below.

Personal & Professional:

Last Name:

Klok

First Name:

Frederikus

Middle Initial:

title_add:

MD, PhD

Phone #:

0031 71 526 2085

Hospital / Institution / Company:

Leiden University Medical Center

Classification:

Other

Position:

Internist in Training

Address:

e-Mail:

f.a.klok@lumc.nl

Street and House Number:

Albinusdreef 2

City:

Leiden

Zip Code:

2316VR

State:

Country:

The Netherlands

Membership benefits:

Site Information:

program for the treatment:

Yes

program set up:

currently taken care:

patients operated:

approximate number:

normally referred: