As the only living desendant of R' Dovid he became the rabbi of Tolna upon his grandfather's death. He was married to his 1st cousin Sima the daughter of R' Moshe Tzvi, son of R' Shimon Shlomo of Savaran.
At left is the grave of Sima Twersky, buried in Chelsea, Massachusetts.
R' Menachem Nochum and Sima had ten children. His oldest child was R' Dovid Mordechai, then R' Moshe Tzvi, R' Meshulem Zusia, R' Yochonon, R' Yitzchok, R' Avrohom, R' Ahron, Chanah Gabai, Feiga Schneider and Chaya Dovreish.
At right is the grave of his son R' Yitzchok, buried in Beth David Cemetery in Elmont, New York