| Regimental number | 17002 |
| Place of birth | Brisbane Queensland |
| Religion | Church of England |
| Occupation | Shop assistant |
| Address | Brisbane, Queensland |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Mother, Mrs A J Coombs, 666 Brunswick Street, New Farm, Queensland |
| Enlistment date | 8 February 1916 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps February 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A16 Port Melbourne on 16 July 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Field Ambulance |
| Fate | Returned to Australia 20 June 1919 |
