| Regimental number | 20011 |
| Place of birth | Sydney New South Wales |
| Religion | Roman Catholic |
| Occupation | Carpenter |
| Address | Leichhardt, New South Wales |
| Marital status | Single |
| Age at embarkation | 21 |
| Next of kin | Mother, Mrs E T Blake, 48 Carrington Street, Leichhardt, New South Wales |
| Previous military service | 31st Infantry |
| Enlistment date | 26 November 1917 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, General Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps |
| Fate | Returned to Australia 2 January 1919 |
