| Regimental number | 123 |
| Place of birth | Palmers Island New South Wales |
| Religion | Church of England |
| Occupation | Hospital attendant |
| Address | c/o W K Fraser, Tyrell Street, Gladsville, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 32 |
| Next of kin | Mother, Mrs Flora Johnson, Palmers' Island, Clarence River |
| Enlistment date | 5 January 1915 |
| Rank on enlistment | Private |
| Unit name | Australian Naval & Military Expeditionary Force (Queensland Reinforcement) |
| Miscellaneous details (Nominal Roll) | Name does not appear on Nominal Roll |
