| Regimental number | 21755 |
| Place of birth | Warrnambool Victoria |
| Religion | Seventh Day Adventist |
| Occupation | Commission agent |
| Address | Yambuk, Victoria |
| Marital status | Single |
| Age at embarkation | 26 |
| Next of kin | Aunt, Mrs A Watts, Yambuk, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Rank from Nominal Roll | Sergeant |
| Unit from Nominal Roll | 2nd Australian General Hospital |
| Fate | Returned to Australia |