Gender: M

Race: C

Birth Date: 12/19/1939

Death Date: 10/17/1968

Place of Birth: Tyler, TX

Year Medical License Issued: 1964

Medical School: Univ. Texas Southwestern Medical School, Dallas

Medical School Location: TX

Degree: MD

Graduation Date: 1964

References:

Certified by TX Board?: Y

Location: Dallas

Specialty:

Secondary Specialty:

Notes: