| Regimental number | 3/169 |
| Address | 61 Hutt Road, Petone |
| Marital status | Single |
| Next of kin | Hickey, Petone, Wellington |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, Main Body, New Zealand Medical Corps |
| Embarkation details | Unit embarked from Wellington on |
| Miscellaneous details | Nominal Roll Vol. 1: Medical Corps/Main Body |