Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP 2190 | MN |
NPI | 1013069400 |
---|---|
Provider Name | Mr. Paul George Ruff |
First Address | Saint Paul, MN 55105-1263 |
Second Address | Saint Paul, MN 55105-1263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17F51RU | BLUE CROSS BLUE SHIELD (01) | MN |