| Regimental number | 1622 |
| Place of birth | Cooktown Queensland |
| Religion | Church of England |
| Occupation | Dentist apprentice |
| Address | Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 25 |
| Next of kin | Mother, Mrs Lilian Elizabeth Bloom, 'Dalwood', Gladstone Road, South Brisbane, Queensland |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 49th Battalion, 2nd Reinforcement |
| AWM Embarkation Roll number | 23/66/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board SS Hawkes Bay on |
| Rank from Nominal Roll | Lance Corporal |
| Unit from Nominal Roll | Dental Corps |
| Fate | Returned to Australia |
| Miscellaneous information from cemetery records | Plaque in Queensland Garden of Remembrance |
| Date of death |