Gender: M

Race: C

Birth Date: 11/06/1931

Death Date: 11/11/1964

Place of Birth: Utica, OK

Year Medical License Issued:

Medical School: Univ. TX Southwestern Medical School, Dallas

Medical School Location: TX

Degree: MD

Graduation Date:

References:

Certified by TX Board?: Y

Location: Dallas

Specialty:

Secondary Specialty:

Notes: