| Regimental number | 3/173 |
| Address | c/o Mrs T Pearce 75 Aro Street, Wellington |
| Marital status | Single |
| Next of kin | Mrs J Mills, 24 Lumburn Avenue, East Ham, Essex, England |
| 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 |