| Regimental number | 4/396 |
| Address | Feilding |
| Marital status | Single |
| Next of kin | Edward Henry Fisher, Feilding |
| 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 |