| Regimental number | 3/415 |
| Address | 34 Church Street, Masterton |
| Marital status | Single |
| Next of kin | Mother, Mrs M Ibbetson, 34 Church Street, Masterton |
| Rank on embarkation | Private |
| Enlistment status | Volunteer |
| Unit name | New Zealand Expeditionary Force, 2nd Reinforcements, New Zealand Medical Corps |
| Embarkation details | Unit embarked from Wellington on |
| Miscellaneous details | Nominal Roll Vol. 1: Medical Corps/Second |