Gender: M

Race: C

Birth Date: 10/04/1931

Death Date: 08/21/1962

Place of Birth: Wolf Point, MT

Year Medical License Issued: 1961

Medical School: Baylor College of Medicine, Houston

Medical School Location: TX

Degree: MD

Graduation Date: 1961

References:

Certified by TX Board?: Y

Location:

Specialty:

Secondary Specialty:

Notes: