| Contact Information | |
|---|---|
| First Name | Nitesh |
| Last Name | Rai |
| Address | dist. sunsari,east Nepal |
| City | dharan |
| State | |
| Province | |
| Zip/Postal Code | |
| Country | Nepal |
| Home Phone | 025 - 524643 |
| Work Phone | - |
| Fax | |
| nitzbantawa@hotmail.com | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Nitesh - Rai |
| Date of Injury | 11/09/2004 |
| Type of Injury | Traumatic |