| Regimental number | 1164 |
| Religion | Roman Catholic |
| Marital status | Single |
| Age at embarkation | 39 |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 22nd Battalion Head-Quarters Staff |
| AWM Embarkation Roll number | 23/39/1 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A38 Ulysses on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Field Company Engineers |
| Fate | Returned to Australia |